Orthognathic Surgery


Preventive and Diagnostic

Orthognathic Surgery

At NYCOMS, orthognathic surgery is the essence of what we do and the focus of our practice. Sometimes called corrective jaw surgery, orthognathic surgery involves moving various components of the facial skeleton to achieve balance, good jaw function and a comfortable jaw position. At times, it improves speaking, chewing of a healthy diet and, in various specific cases, opening and improving the airway. Orthognathic surgeons are “orthopedic surgeons of the facial skeleton.” Most orthognathic surgery is performed upon the interior of the mouth within a hospital setting, although some patients can be treated in an office or ambulatory setting as well. Our doctors work only in the finest teaching hospitals and facilities.

When a patient comes in with a jaw abnormality, we first evaluate how the patient is affected on a level of functionality (whether they can chew a healthy diet, whether they have a proper dental occlusion, whether they speak clearly, whether they can breathe, whether they have pain, whether they have a good level of self-esteem about their smile and their appearance). Once we evaluate those problems, then we evaluate the patient’s anatomy.


The Professional Team


The final treatment plan is developed by your NYCOMS surgeon and orthodontist with the patient’s input. Collaborating with other dental professionals helps to ensure the plan’s success. Orthodontic work is required in most cases prior to moving the bones with surgery to ensure that, when the jaw is set, the occlusion is correct. Afterwards, orthodontic work is used to refine the bite once the bones are healed. We work with your dentist throughout the entire process to make sure that the teeth and supporting structures are in excellent health. The functional aspect and the stability aspect of the correction is ensured by the orthodontic preparation and the post-surgical orthodontic work.


About Orthognathic Surgery


Procedures


Orthognathic surgery is done to correct misalignments or other abnormalities in the upper and/or lower jaw.

There are only three basic orthognathic procedures:

  • Moving the upper jaw: Lefort 1 Osteotomy
  • Moving the lower jaw: Bilateral Sagittal Splitting of the Mandible
  • Moving the chin: Genial Osteotomy or Anterior Mandibular Osteotomy (moving the chin to create facial balance)

Each of these procedures permits the surgeon to move the jaw in the direction required to correct the underlying abnormal jaw relationships. The above procedures are uniquely combined in each case to correct the unique jaw abnormalities of each patient. The decision as to what operations to do and which direction to move the jaw are based on a meticulous clinical examination, accurate records including clinical photographs, cone beam CT three dimensional analysis and dental study models.

Overview


Orthognathic surgery can involve procedures such as osteotomies (bone cutting), bone grafts, distraction osteogenesis (stretching of the bone) and orthodontic (braces) care.  Orthognathic correction is conducted in stages and the course of treatment can last from a few months to a year or more.

In order to perform the procedure successfully, the jawbones will be repositioned in accordance with each patient’s specific needs.  Inconspicuous incisions are usually made inside the mouth, and if needed, outside the mouth, to allow for surgical plates, screws, wires and rubber bands to be used to hold the patient’s jaws in the new positions.

Several surgical techniques have been developed to allow our surgeons to reposition the upper or lower jaw or sometimes both. The goals of surgery are to balance the skeleton and the bite thereby improving function, speech, breathing, chewing and esthetics. Once the bone is in the correct position, then the orthodontist can properly finish aligning the teeth. This type of surgery is typically done once skeletal growth is complete.

Orthognathic surgery can be performed on patients of all ages.


Goals of Orthognathic Surgery
• To achieve the ability to incise and masticate a healthy diet
• To insure the ability to have a healthy dentition for life
• To obtain treatment for chronic orofacial pain and dysfunction
• To obtain the ability to speak free from stigmata of nasality or disarticulate speech
• To establish a patent upper airway
• To obtain self esteem emanating from a normal facial proportion and esthetic profile


Stages of Orthognathic Correction


An evaluation with a member of our maxillofacial team is the first step. This typically takes about an hour at your initial visit. This is the time when all of the data is collected such as radiographs, photography, models, facial measurements and a health history. It is important to inform your surgeon about any previous surgeries, hospitalizations, and /or medications as this information may have an impact on your surgical care and planning for a safe anesthetic. Be sure to include any herbal or holistic therapies when providing this information.

A second follow up visit to the office will allow us the necessary time to compile the data and create the analysis necessary to determine if corrective jaw surgery is appropriate for you. This will be discussed at length with you and any family members that may come. A demonstration of computer generated surgery on you at that time may be available. This also takes about an hour.

A visit to the orthodontist is the next step in the process in preparation for orthognathic surgery. The doctor will place appliances (braces) on your upper and lower teeth to align and level them into the correct position within the bone. Typically it takes any where from 6 to 12 months of preparation. During that time we will be checking on you periodically to see the progress of tooth alignment so that we may plan ahead for your surgical date. Almost all patients having corrective jaw surgery require pre-surgical orthodontic preparation to align the teeth so when the jaw is set, the dental occlusion is correct. The orthodontic appliances are placed before surgery and stay on during and after. Dental elastics between the upper and lower braces are used like a soft cast to guide the jaw into its new position. Unlike in the past, the jaws do not have to be wired shut. This is because of the use of titanium plates and screws which stabilize the jaw.
Once the alignment of the teeth is accomplished you will come back to us for a final surgical work up. At this time we will be taking new records. We will create a scale model of your jaws and perform the surgery to create guides to use in the operating room. This allows us to navigate through your surgery smoothly and precisely position the bones into the correct position.
The operation takes place in one of the many hospitals we are affiliated with. The average length of stay for jaw surgery is one night.
Once the surgery is completed the bones that have been repositioned at this point are healing into their new location. It takes 8 weeks for the bone to be hard enough to return to full function. Thus a diet of liquid to soft consistency is necessary so as not to traumatize the delicate healing bone. Your physical activity will be limited to no strenuous activity for a period of time, depending on the surgical procedures performed.
When the bones are stable the orthodontist can resume aligning the teeth for a ideal fit. Orthodontic retainers are used to maintain stability of the bone and the bite as the final stage of orthodontic treatment.